title: Diagnostic potential of endotoxin scattering photometry for sepsis and septic shock.
abstract: Endotoxin scattering photometry (ESP) is a novel Limulus amebocyte lysate (LAL) assay that uses a laser light-scattering particle-counting method. In the present study, we compared ESP, standard turbidimetric LAL assay, and procalcitonin assay for the evaluation of sepsis after emergency gastrointestinal surgery. A total of 174 samples were collected from 40 adult patients undergoing emergency gastrointestinal surgery and 10 patients with colorectal cancer undergoing elective surgery as nonseptic controls. Plasma endotoxin levels were measured with ESP and turbidimetric LAL assay, and plasma procalcitonin levels were assessed with a standard procalcitonin assay. Plasma endotoxin and procalcitonin levels increased corresponding to the degree of sepsis. Endotoxin scattering photometry significantly discriminated between patients with or without septic shock: sensitivity, 81.1%; specificity, 76.6%; positive predictive value, 48.4%; negative predictive value, 93.8%; and accuracy, 77.6%. The area under the receiver operating characteristic curve for septic shock with the ESP assay (endotoxin cutoff value, 23.8 pg/mL) was 0.8532 ± 0.0301 (95% confidence interval, 0.7841-0.9030; P < 0.0001). The predictive power of ESP was superior to that of turbidimetric assay (difference, 0.1965 ± 0.0588; 95% confidence interval, 0.0812-0.3117; P = 0.0008). There was no significant difference in predictive power between ESP and procalcitonin assay. Endotoxin scattering photometry also discriminated between patients with and without sepsis. Area under the receiver operating characteristic curve analysis showed that ESP had the best predictive power for diagnosing sepsis. In conclusion, compared with turbidimetric LAL assay, ESP more sensitively detected plasma endotoxin and significantly discriminated between sepsis and septic shock in patients undergoing gastrointestinal emergency surgery.
authors.affiliation: Departments of *Surgery and †Emergency and Critical Care Medicine, Shiga University of Medical Science, Otsu, Japan.
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Shimizu
authors.forename: Toru
authors.initials: T
authors.lastname: Obata
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Sonoda
authors.forename: Hiroya
authors.initials: H
authors.lastname: Akabori
authors.forename: Tohru
authors.initials: T
authors.lastname: Miyake
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Takahisa
authors.initials: T
authors.lastname: Tabata
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Eguchi
authors.forename: Tohru
authors.initials: T
authors.lastname: Tani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D004630:Emergencies; D004731:Endotoxins / Q000097:blood*; D005260:Female; D041981:Gastrointestinal Tract / Q000601:surgery; D006801:Humans; D007834:Lasers; D008033:Limulus Test / Q000379:methods; D008297:Male; D008875:Middle Aged; D009391:Nephelometry and Turbidimetry / Q000379:methods; D010783:Photometry / Q000379:methods*; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D012542:Scattering, Radiation; D018805:Sepsis / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D012772:Shock, Septic / Q000097:blood / Q000175:diagnosis / Q000382:microbiology
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D004731:Endotoxins; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide